<div class="findtrs">
	<form action="" class="layui-inline" method="post">
		<div class="ftitle">
			<div class="lt">
				<h2>银行电汇（美国境内Domestic Wire汇款）</h2>
			</div>
		</div>
		<div class="fremittance fbai">
			<div class="fnobeinfo">
				<div class="ftl"><h3>1.收款信息</h3></div>
				<div class="fremitls">
					<ul>
						<li>
							<div class="receiving">
								<div class="fre">Receiving Bank Details</div>
								<dl>
									<dd>
										<label class="lab">Bank Name（银行名称）</label>
										<input type="text" class="info" name="" placeholder="Evolve Bank and Trust" >
									</dd>
									<dd>
										<label class="lab">Bank Address（银行地址）</label>
										<input type="text" class="info" name="" placeholder="6070 Poplar Ave, Suite 200, Memphis, TN 38119" >
									</dd>
									<dd>
										<label class="lab">ABA/Routing Number（美国国内汇款码）</label>
										<input type="text" class="info" name="" placeholder="084106768" >
									</dd>
								</dl>
							</div>
						</li>
						<li>
							<div class="receiving">
								<div class="fre">Beneficiary Information</div>
								<dl>
									<dd>
										<label class="lab">Account Holder（账户名称）</label>
										<input type="text" class="info" name="" placeholder="CARDPALACE" >
									</dd>
									<dd>
										<label class="lab">Account Number（账户号码）</label>
										<input type="text" class="info" name="" placeholder="9801570396" >
									</dd>
									<dd>
										<label class="lab">Account Address（账户地址）</label>
										<input type="text" class="info" name="" placeholder="18104 Cowbell Court, Rowland Heights, CA 91748" >
									</dd>
									<dd>
										<label class="lab">Type of Account（账户类型）</label>
										<input type="text" class="info" name="" placeholder="Checking" >
									</dd>
									<dd class="ho">
										<label class="lab">Ref# / Memo#（转账备注）</label>
										<input type="text" class="info" name="" placeholder="18062009694" >
										<div class="fnote">
											Note：<br />
											1.Must put Ref# / Memo# when you send funds (发送款项时请务必填写转账备注，否则资金无法到账！)<br />
											2.付款金额建议充值非整数，增加审核速度，如：$1000.23<br />
											3.当前付款方式单笔最低充值$100, 最高$4999, 非范围内金额不予入账<br />
										</div>
									</dd>
								</dl>
							</div>
						</li>
					</ul>
				</div>
			</div>
		</div>
		<div class="fremittanpred fbai">
			<div class="txt">
				<h2>2.提交汇款预报<i>（预计2022-08-24前到账）</i></h2>
				<p>完成汇款操作后，请尽快填入您的汇款详情并上传汇款底单，提交审核成功后方能完成美金账户充值。请注意核实录入的信息，以免影响您的充值进度。</p>
			</div>
			<div class="list">
				<ul>
					<li>
						<label>Wire Date电汇日期 <i>*</i></label>
						<div class="time" >
							<input type="text" id="test1" class="info" name="" placeholder="请选择日期" >
							<div class="fic"><img src="__STATIC__/lib/index/images/fd7.png" alt=""></div>
						</div>
					</li>
					<li>
						<label>Transfer Amount 付款金额，最低$100 <i>*</i></label>
						<div class="rt">
							<h4>$</h4>
							<input type="text" class="info" name="" placeholder="" >
						</div>
					</li>
					<li>
						<label>Payer's Account Name 付款人户名<i>*</i></label>
						<input type="text" class="info" name="" placeholder="请输入付款人户名" >
					</li>
					<li>
						<label>Payer's Account Number 付款人帐号<i>*</i></label>
						<input type="text" class="info" name="" placeholder="请输入付款人账号" >
					</li>
					<li>
						<label>Payer's Bank Area付款银行区域<i>*</i></label>
						<select name="" class="lsele">
							<option value="">US美国国内</option>
							<option value="US美国国内1">US美国国内1</option>
							<option value="US美国国内2">US美国国内2</option>
						</select>
					</li>
					<li>
						<label>Payer's Bank Name付款银行名称<i>*</i></label>
						<select name="" class="lsele">
							<option value="">请选择付款银行名称</option>
							<option value="美国银行">美国银行</option>
							<option value="美国银行1">美国银行2</option>
						</select>
					</li>
					<li>
						<label>Payer's Bank TRN#付款银行交易号<i>*</i></label>
						<input type="text" class="info" name="" placeholder="请输入付款银行交易号" >
					</li>
					<li>
						<label>&nbsp;</label>
						<div class="fzhu">注：所有额外费用均由付款方承担</div>
					</li>
					<li class="fload">
						<label>付款交易截图</label>
						<div class="fupload">
							<input type="file" class="file" name="" >
							<div class="en">
								<div class="ico"><img src="__STATIC__/lib/index/images/fd6.png" alt=""></div>
								<h4>立即上传</h4>
							</div>
						</div>
					</li>
				</ul>
			</div>
			<input type="submit" class="fsubmit" name="submit" value="提交审核" >
		</div>
	</form>

</div>
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